Adherence communication: a qualitative analysis of physician-patient dialogue.

OBJECTIVE: To explore how HIV/AIDS care physicians communicate with HIV-positive patients about the need for adherence to antiretroviral treatment regimens.

DESIGN: Semi-structured, face-to-face interviews, a qualitative research method.

SETTING: A comprehensive, multidisciplinary, HIV/AIDS practice at San Francisco General Hospital.

PARTICIPANTS: Fifteen physicians, most of whom (73%) were board certified in internal medicine and/or infectious diseases; all were involved in HIV continuity care.

RESULTS: Most physicians engaged in both pre- and post-prescription phases of adherence communication with their patients. During the pre-prescription phase, physicians made decisions about offering prescriptions to patients, often based on their beliefs about the patient's likelihood of adhering to therapy. During the post-prescription phase, physicians asked patients questions about if/how they were adhering to the regimens. Physicians' practices, such as the length of time spent in the pre-prescription phase, the timing of the 'check-ins' in the post-prescription phase, and the overall content of both phases, varied significantly.

CONCLUSIONS: Physicians have diverse ways of communicating with patients regarding adherence to antiretroviral medications. The effect of such communication on treatment outcomes needs to be assessed; however, the potential benefit suggests that training programs should be developed to improve physicians' skills in this area. Further studies should be done to assess how generally applicable these findings are to other groups of physicians.